Not too long ago, a tax advisor I’ve been working with mentioned his health goals. “I want to remain mobile, functional, and mentally clear for a long as possible, so that I can enjoy and help people.” Wow. I might not have remembered the exact quote accurately, but to me what was important was the concept. I’d never really thought about my own health this way, and although I’ve been in practice for almost 10 years, I realize I have not always framed my patient’s health around their goals.
I know there is a benefit to reducing one’s average blood sugar below a certain point, and that taking statin medications can reduce the risk of heart attack or stroke as we age, but what is my patient wanting to achieve? I have had a general sense of what might be important to a particular patient, but I have not actually asked, “What are your health goals?” Maybe achieving tight blood sugar control is less important to you than the desire to avoid injecting insulin when eating out with friends. What limits full achievement of these goals? Maybe the cost of medication is competing with the lifelong desire to save for a trip to Europe, or even competing with the cost of food. Every person has a story – you have a story – and you want your doctor to understand your story, really know you well, to be able to give you the best advice for you.
As a physician, I would love to help you, my patient, achieve your goals. Nothing makes me more satisfied than helping people be successful with their health. In order to help you then, I need to know what your goals are, and I need you to help me understand the constraints and limits that you see and feel in your life. I need you to tell me. If you have diabetes, is it important to you to put in your 100% best effort to prevent complications like heart disease or kidney failure? We can develop a plan for that. Maybe your goal is to have the best control of your blood sugar without needing insulin injections. I can help you with that strategy with you as well. Perhaps it is finally getting your thyroid medication formulated correctly after visiting three other endocrinologists. You want to use medications with the best chance to help you lose weight? Let’s focus on that. We need to discuss what’s important to you.
If you don’t have health goals in mind already, a good first step would be to think about and prioritize what is important you now, what you are concerned about in your future, and what trade-offs or sacrifices you are willing to make to achieve your goals.
The goal of “remaining mobile” mentioned above is one that I have adopted. I’ve struggled to keep exercising with my crazy schedule, and I know that a program of stretching and core strength development helps tremendously to limit pain and keep me active. But I’ll admit I don’t really enjoy doing these. So, I accept that the “sacrifice” of doing core exercises is worth the benefit to keep me fully mobile.
For you, maybe everyone in your family develops type 2 diabetes, and you really want to avoid developing this condition. What do you need to do to reduce your risk, and what are you willing to do to help yourself achieve this goal? Exercise and weight loss, if you are overweight, can reduce the risk of developing type 2 diabetes by at least 50%! What would it take for you to fully commit to a plan of exercise and weight loss? What gets in your way?
Let’s look at a second step now. Once you’ve thought about your goals a bit, maybe you can pencil in 2 or 3 things that you’d like to work with for now.
What can you do to help achieve your goals? Are you doing these things? What gets in your way or sabotages your attempts? Let’s say you have arthritis in your knees, and a goal you have is to reduce your knee pain so you can walk when you travel with your spouse, something you enjoy together. That would be a wonderful goal, don’t you think? As your physician, I might advise you that losing 10-20 pounds will help with your pain, and that physical therapy to strengthen the muscles around the knee can be beneficial. Are you willing to do these? What would get in your way? Can you find a way to work through problems? I’d love to try to help you with this. It would be great for you to have a concrete strategy that you could follow to move toward your goals.
A third step would be to periodically assess your goals, what is working well, and where you may have gone off track and need to refocus some time and energy. Life is rarely a process that goes in a straight line. It is full of distractions and interruptions that knock us all off track. If we don’t refocus at times, it is hard to keep making progress. Or maybe, things are going so well with your current goals you feel like taking on a new goal at this point. Wouldn’t that be awesome?